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Aggiornato: 1 giorno 13 ore fa

[Editorial] Children and social media

Sa, 13/01/2018 - 00:00
Social media is an increasingly common and integral part of people's lives, including those of children, despite a minimum access age of 13 years for some platforms. The reach of social media has outpaced research into potential benefits and harms for younger users. To address this gap, the Children's Commissioner for England, Anne Longfield, published Life in ‘likes’ on Jan 4, to explore the social media experience of children aged 8–12 years.

[Editorial] A new vaccine for typhoid control

Sa, 13/01/2018 - 00:00
Last week, WHO announced prequalification of the first conjugate vaccine to prevent typhoid (Typbar TCV, manufactured by Bharat Biotech, India) after the publication of randomised controlled trials, including that by Celina Jin and colleagues in The Lancet on Sept 28, 2017. WHO has decided that Typbar TCV was successfully assessed for quality, safety, and efficacy, and it is now approved for distribution by UN agencies. Already in use in India and Nepal in babies older than 6 months, the vaccine is to be licensed for use in infants younger than 2 years.

[Editorial] Sanctioning the most vulnerable—a failed foreign policy

Sa, 13/01/2018 - 00:00
Over past months, US-led threats of, or implementation of, economic sanctions have multiplied. On Jan 4, the USA suspended assistance to Pakistan until it takes “decisive action” against Afghan Taliban and the Haqqani network militant groups. From Jan 2, President Donald Trump indicated he would pull funding for the UN Relief and Works Agency for Palestine Refugees saying Palestinians were “no longer willing to talk peace”. This followed the adoption by the UN security council, in December, 2017, of draconian US-drafted sanctions on North Korea in response to a ballistic missile test.

[Comment] Oral fexinidazole for human African trypanosomiasis

Sa, 13/01/2018 - 00:00
Human African trypanosomiasis caused by Trypanosoma brucei gambiense (g-HAT) is transmitted to human beings by tsetse flies in western and central Africa. Human beings are the only significant reservoir of the protozoan parasite, and disease control is focused on the detection and treatment of infected individuals, with or without vector control. Screening for cases can be passive (individuals are examined at fixed centres) or active (mobile teams travel to villages). The card agglutination test for trypanosomiasis and recently developed rapid diagnostic tests are the serological methods used for screening.

[Comment] Scaling up integration of health services

Sa, 13/01/2018 - 00:00
Almost 40 years after the Alma-Ata Declaration1 championed a comprehensive vision of health service delivery (panel), the movement towards universal health coverage (UHC) has seen the global health policy pendulum swing back towards the need for integrated people-centred health systems.2–4 For UHC to be sustainable, resources cannot be wasted on services that are inaccessible, fragmented, and of poor quality. There is a growing need to increase the responsiveness and efficiency of service delivery and to put the needs of people and communities back at the centre of health systems.

[Comment] Chronic liver disease: scavenger hunt for novel therapies

Sa, 13/01/2018 - 00:00
Chronic liver disease (CLD) is a major cause of global mortality and morbidity. However, therapeutic breakthroughs have been made in the field of viral hepatitis, with the development of direct-acting antiviral agents (DAAs) to treat hepatitis C virus infection.1 Despite this breakthrough, the incidence of liver disease continues to rise, driven in particular by the increase in obesity-related fatty-liver disease and the consequences of excess alcohol consumption.2 Patients with CLD are at an increased risk of developing progressive liver fibrosis, cirrhosis, and liver failure.

[Comment] Offline: Time to act on minimum unit pricing of alcohol

Sa, 13/01/2018 - 00:00
On Jan 22, the UK's House of Commons Health Select Committee, together with the Home Affairs Committee, will hold one of the most important meetings in the recent domestic political history of public health—on minimum unit pricing of alcohol. Chaired by independent-minded Conservative Member of Parliament and former general practitioner, Sarah Wollaston, the committee will review evidence for and against minimum unit pricing at a moment when liver disease is on a trajectory to become the biggest cause of death in England and Wales.

[World Report] Malaysia: a refugee conundrum

Sa, 13/01/2018 - 00:00
Malaysia is home to hundreds of thousands of registered and unregistered refugees, most of whom are Rohingya, but it does not recognise the refugee status. Adam Bemma reports.

[World Report] Iranian protests and Rouhanicare

Sa, 13/01/2018 - 00:00
Iranians have risen up to protest economic and job instability. How is President Hassan Rouhani's once popular health-care project, the so-called Rouhanicare, fairing? Sharmila Devi reports.

[World Report] Doctors disagree with proposed medical bill in India

Sa, 13/01/2018 - 00:00
A controversial bill to reform medical education in India, the National Medical Commission bill, prompted doctors to call for a nationwide strike. Patralekha Chatterjee reports.

[Perspectives] A literary pain scale

Sa, 13/01/2018 - 00:00
As an English professor, I often teach classes that examine how medical institutions, medical science, and medical practitioners appear in literature. Again and again, as students read plays, novels, non-fiction, and essays, they take note of the language gap between physicians and patients—the gap in how doctors discuss disease or disorder and how patients represent the experience of illness.

[Perspectives] Truth and information

Sa, 13/01/2018 - 00:00
“I'm mad as hell and I'm not going to take it anymore”. This iconic rallying cry was originally made by actor Peter Finch, as news anchorman Howard Beale, in Paddy Chayefsky's 1976 film Network. The same cry is now echoing in the Lyttelton Theatre, at the UK's National Theatre in London, in a stage adaptation of the movie by Lee Hall. Under the direction of Belgian director Ivo van Hove, American actor Bryan Cranston makes his debut on the British stage in a pitch-perfect performance as Howard Beale.

[Perspectives] Man-made disaster

Sa, 13/01/2018 - 00:00
In its last years, the Soviet Union was not meeting the needs of its citizens. One simple measure, life expectancy at age 15 years, showed the USSR to fall progressively further behind western Europe, all through the 1970s and 1980s. It was meeting material needs of its population—infant mortality was fairly low, and people had enough to eat—but not spiritual needs, to use the words of Mikhail Gorbachev, last General Secretary of the Communist Party of the Soviet Union. Deaths from heart disease were high, as were violent and other alcohol-related deaths.

[Perspectives] Natalia Kanem: lifelong advocate for women's health and rights

Sa, 13/01/2018 - 00:00
”My big disappointment is that women's rights are still not at the centre”, says Natalia Kanem, echoing her lifelong “passion and hope” for women's health and rights. Her interest in these issues started in 1975 when, as an undergraduate at Harvard University, she attended the first UN World Conference on Women. Appointed as the Executive Director of the United Nations Population Fund (UNFPA) in October, 2017, Kanem hopes she “can really affect the fate of some of the poorest and most vulnerable women and girls in the world”.

[Perspectives] Changing minds about changing behaviour

Sa, 13/01/2018 - 00:00
Most of us value our health highly yet act in ways that undermine it. If we ate and drank less, didn't smoke, and were physically more active, 40% of cancers and 75% of diabetes and cardiovascular disease would be avoided. Because these behaviours tend to cluster by deprivation, achieving these changes for everyone could also halve the gaps in life expectancy and years lived in good health between the rich and the poor. In the UK, around 16% of the population smokes, the lowest figure for many decades, although among those who are poorest this rate is doubled.

[Obituary] Shila Kaur

Sa, 13/01/2018 - 00:00
Malaysian public health expert and advocate for access to medicines. Born in George Town, Malaysia, on March 13, 1962, she died of breast cancer in Los Angeles, CA, USA, on Nov 21, 2017, aged 55 years.

[Correspondence] Saving the Joint Comprehensive Plan of Action: full of hope or just hopeless?

Sa, 13/01/2018 - 00:00
On July 14, 2015, Iran, the P5+1 countries (China, France, Russia, UK, USA, and Germany), and the European Union signed a landmark nuclear agreement that officially went into effect on Jan 16, 2016.1 Under the Joint Comprehensive Plan of Action (JCPOA; also known as the Iran nuclear deal), Iran was to put severe limitations on its nuclear programme in exchange for the removal of international sanctions. After signing this agreement, Iranian scientists considered it an historic opportunity for the scientific community, and they became hopeful that lifting the sanctions could gradually help their scientific advancements in many ways.

[Correspondence] Treaty to prohibit nuclear weapons and Germany's global health responsibility

Sa, 13/01/2018 - 00:00
The adoption of the Treaty on the Prohibition of Nuclear Weapons by the UN1 and the immediate support by 50 nations is, as Andy Haines and Helfand2 note, “a victory for the public health perspective over the misguided national power and security considerations that have dominated nuclear policy” for decades. Strong support for the treaty by countries with a commitment to global health is needed to safeguard humanity.

[Correspondence] Singapore should play a strong leadership role in global health

Sa, 13/01/2018 - 00:00
The regions of the Association of Southeast Asian Nations continue to face several health threats associated with infectious and chronic diseases, ageing populations, and inadequate clean water and sanitation. Collective action is needed among the Asian countries to deal with these threats, and Singapore has much to offer in terms of knowledge and innovations.1 In 2017, Singapore was ranked in the top position in progress towards the health-related UN Sustainable Development Goals2 and in the Global Innovation Index 2017 (a metric among Asian countries).

[Correspondence] Questions regarding the CONCERN trial

Sa, 13/01/2018 - 00:00
Findings from Francis Chan and colleagues' study (June 17, 2017, p 2375)1 showed a 6·7% absolute risk reduction in recurrent upper gastrointestinal bleeding with celecoxib plus esomeprazole compared with naproxen and esomeprazole in patients who were on non-steroidal anti-inflammatory drugs and receiving concomitant aspirin following an upper gastrointestinal bleed. Additionally, the authors reported no significant difference between groups in serious cardiovascular events (4·4% [95% CI 2·4–7·7] for patients given celecoxib plus esomeprazole vs 5·5% [3·3–9·2] for those given naproxen plus esomeprazole; p=0·543), although their study was not adequately powered to evaluate this secondary outcome.